Objective To investigate a suspected outbreak of hospital-acquired infections caused by Mycobacterium chelonae related to flexible bronchoscope (hereinafter referred to as “bronchofibroscope”) and apply targeted high-throughput sequencing (tNGS) technology for etiological analysis, providing references for controlling hospital infection outbreaks. Methods A retrospective survey of patients who were detected with Mycobacterium chelonae through tNGS testing of bronchoalveolar lavage fluid (BALF) after bronchofibroscopy at the Zhengdong District, People’s Hospital of Henan University of Chinese Medicine, People’s Hospital of Zhengzhou between May 1, 2018 and March 18, 2024. The causes were investigated through comprehensive measures including on-site epidemiological surveys and environmental health assessments, and intervention measures were developed and evaluated for effectiveness. Results A total of 52 patients were included. Mycobacterium chelonae was detected in 30 patients, nosocomial infection was excluded in all cases. The suspicious contaminated bronchofibroscope lavage fluid and its cleaning and disinfection equipment, environment and other samples were collected. The traditional microbial culture results were negative. The tNGS results showed that Mycobacterium chelonae was detected in bronchofibroscope lavage fluid (sequence number 156), and all the patients with Mycobacterium chelonae detected in BALF used the bronchofibroscope. It was judged that this event was a pseudo-outbreak of nosocomial infection caused by the contamination of bronchofibroscope with the patient’s BALF. After three months of continuous follow-up after the comprehensive control measures were taken, Mycobacterium chelonae was not detected by tNGS in bronchofibroscope lavage fluid or patients’ BALF. All patients in the hospital improved and discharged without any new cases. The pseudo-outbreak of nosocomial infection was effectively controlled. Conclusions There are many links in the reprocessing of bronchofibroscope, which is easy to cause pollution, and the management needs to be strengthened. tNGS detection has the characteristics of high efficiency, few background bacteria and clear pathogen spectrum, which can be used as a supplementary means for the investigation of nosocomial infection outbreaks, and is of great significance for identifying the source of infection and determining the transmission route.
目的:探讨纤维支气管镜(简称纤支镜)肺泡灌洗术在治疗肺部感染性疾病的疗效。方法:共从内科系统中入选社区获得性肺炎和医院获得性肺炎患者122例,将其分为二组,治疗组:传统治疗加纤支镜肺泡灌洗术治疗肺部感染,共52例;对照组:传统方法治疗肺部感染,共70例。结果:两组病例在发热时间,咳嗽,咳痰及肺部罗音消失时间,住院日,抗生素使用时间,治愈率和死亡率方面对比均有显著性差异(Plt;0.05)。结论:纤支镜肺泡灌洗术在治疗肺部感染性疾病的疗效确切,且术中危险性小,值得推广。
Malignant airway stenosis generally refers to airway lumen stenosis caused by various primary and metastatic malignant tumors and restricted airflow, which can be manifested as dyspnea to varying degrees or even asphyxia and death. It seriously affects the quality of life of patients with airway stenosis. With the continuous development of bronchoscope interventional techniques, various interventional therapies such as ablation, dilation and stent implantation can be used to reventilate the airway. Among them, ablation treatment is the most commonly used method. The methods of ablation treatment include cold, heat, photodynamic, local chemoradiotherapy, etc. This article will review the new applications of various methods used in the ablation treatment of malignant airway stenosis progress.
Objective To improve the knowledge on dynamic benign central airway stenosis through two typical cases. Methods The clinical features, imaging findings, and bronchial morphologic changes of two cases characterized by dynamic benign central airway stenosis were retrospectively analyzed. The etiologies for the two cases were tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC), respectively. Results Central airway stenosis and reversible airway obstruction were common clinical characteristics for the two cases. However, there were identifiable differences on imaging findings and bronchial morphologic changes between the two cases. Multidetector computed tomography showed sabre-sheath trachea and narrowed trachea in coronal position for TBM, while small sized trachea in exhalation phase and narrowed trachea in sagittal position for EDAC. Bronchoscopy displayed narrowed airway, swelling mucosa, and the absence of annular cartilage for TBM, while crescent airway with membranacea part protruding to lumen in inspiration phase, and the integrity of annular cartilage for EDAC. Conclusion Multidetector computed tomography and bronchoscopy examinations are valid methods to distinguish TBM and EDAC, which are both characterized by dynamic benign central airway stenosis.
ObjectiveTo explore the diagnostic value of endobronchial ultrasonography with a guide sheath (EBUS-GS) for pulmonary fungal disease.MethodsAll patients were collected from January 2015 to December 2018. They were diagnosed with pulmonary fungal disease by tissue biopsy, body fluid or blood test, and without other diseases such as pneumonia, lung cancer, lung abscess, tuberculosis, or organizing pneumonia, etc. After clinical anti-fungal treatment, clinical symptoms were relieved, chest CT lesions were absorbed, laboratory-related checks were turned negative in these patients. All patients underwent bronchoscopy, bronchoalveolar lavage fluid/brush examination, and blood galactomannan antigen test/latex agglutination test. They were divided into an EBUS-GS group and a non-EBUS-GS group according to whether EBUS-GS check was performed. Non-parametric test was used to analyze the diagnostic value of EBUS-GS in pulmonary fungal diseases.ResultsFifty-one patients were included and 20 patients in the EBUS-GS group and 31 patients in the non-EBUS-GS group. The EBUS-GS group had a higher positive rate of pulmonary fungal disease. The diagnostic rates of the EBUS-GS group and the non-EBUS-GS group were statistically different (90.0% vs. 48.4%, P<0.05).ConclusionEBUS-GS can improve the diagnosis rate of pulmonary fungal disease and provides further evidence for a clear diagnosis.
ObjectiveTo explore the safety and efficacy of the treatment of peripheral bronchopleural fistula with customized silicone plug through bronchoscope. MethodsA total of 19 patients with BPF admitted to Hunan Provincial People’s Hospital from July 2017 to May 2023 were included. Detailed medical records of the patients were collected, including etiology, fistula location, treatment methods, complications, and effective rates, to assess the safety and efficacy of customized silicone plug occlusion. ResultsThe average age of the 19 patients was 61.58 years (range from 42～84 years). The fistulas were located at the right upper lobe in 8 cases, the right middle lobe in 2 cases, the right lower lobe in 2 cases, the left upper lobe in 2 cases, and the left lower lobe in 5 cases. Causes included 9 cases after pneumonectomy, 6 cases of spontaneous pneumothorax, 1 case post Microwave Ablation Therapy for lung nodule, 1 case of advanced lung cancer under radiotherapy and chemotherapy, 1 case of candidal pneumonia, and 1 case of pulmonary tuberculosis. 15 patients were successfully occluded for the first time, 1 case failed to place the plug, and 3 cases had silicone plug dislodgement within 1 week after the procedure, with a short-term effective rate of 73.68% (14 cases). A total of 40 customized silicone plugs were placed, with an average of (2.10±0.74), and the mean diameter of the plugs used was 6.4 mm, with a range of 3 to 9 mm. Fifteen patients were recruited for long-term follow-up, with a median follow-up time of 15 months (range from 1.5 to 53 months). One patient developed a new fistula on the 45th day, who was treated with a combined small Y-type single bullet-covered stent for occlusion. One patient died of severe pneumonia 3 months postoperatively, and one died of type II respiratory failure at the 30th month, both deaths were unrelated to the interventional procedure. The long-term effective rate was 68.42% (13 cases). ConclusionPlacing customized silicone plugs through bronchoscopy can rapidly and effectively occlude peripheral BPF, with satisfactory long-term outcome.
ObjectiveTo investigate the diagnostic value and safety of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary nodules.MethodsThe clinical imaging, surgical and pathological data of 60 patients with 76 peripheral pulmonary nodules who underwent electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound guided biopsy in the Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School from June 2020 to June 2021 were retrospectively analyzed. The diagnosis rate and complications were analyzed and summarized. The 76 pulmonary nodules were divided into a small pulmonary nodules group (10 nodules, diameter≤1 cm) and a pulmonary nodules group (1 cm<diameter≤3 cm, 66 nodules) according to diameter. The two groups were compared in terms of operation and diagnosis rate.ResultsPulmonary nodules diameter was 1.8±0.6 cm, operation time 29.8±8.6 min, navigation 2.9±0.9 times, biopsy 9.5±1.9 pieces. In the 76 pulmonary nodules, 55 were confirmed by pathology, with a total diagnosis rate of 72.4%, including 32 of malignant lesions and 23 of benign lesions. In the 76 pulmonary nodules, 59 had grade 0 hemorrhage, 17 had grade 1 hemorrhage, and none had grade 2 or more serious hemorrhage. Eight patients developed pneumothorax after surgery, and the degree of lung compression was less than 30%, which was improved after symptomatic treatment with oxygen inhalation. The operation time in the small pulmonary nodules group was significantly longer than that in the pulmonary nodules group, and there was no significant difference in diagnosis rate or complications between the two groups.ConclusionElectromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound is a safe and effective method for the diagnosis of periphery pulmonary nodules, and it also has a high diagnostic rate for small pulmonary nodules (≤1 cm), which is worthy of clinical promotion and application.
Objective To explore the safety and efficacy for patients with central airway-pleural fistula (APF) treated by atrial septal defect (ASD) occluder. Methods This was a retrospective study. Between January 2017 and October 2021, a total of 16 patients with postoperative APF were treated with ASD occluder through bronchoscope under local anesthesia combined with sedation. The efficacy and complication were recorded during and after the procedure. Results Sixteen patients were recruited in this study and the average age was 60.7 years (range 31 - 74 years). The main etiology for APF was lobectomy/segmentectomy (n=12), pneumonectomy (n=2), radical esophagectomy (n=1) or decortication for chronic empyema (n=1). Totally, 4 fistulas were located in right main bronchus, 3 in left main bronchus, 3 in right upper bronchus, 1 in right middle bronchus, 2 in right lower bronchus and 3 in left upper bronchus. The median diameter of APF was 7.8 mm (ranged from 4 to 18 mm) and the median diameter of ASD occluder inserted was 10.0 mm (ranged from 6 to 20 mm). Successful occlusion of APF was observed in 15 patients (15/16) and 1 patient died of multiple organ failure caused by bacteremia 14 days after the procedure. Fourteen patients were recruited for long-term follow-up, on a median follow-up period of 16.2 months (ranged from 3 to 46 months). There were 12 patients of complete remission and 2 patients of partial remission and only one patient took a second operation due to the enlargement of fistula and translocation of occluder. At follow-up, 4 patients died and the reasons were directly related to the primary etiology, and no patient died due to APF recurrence. Conclusion Endobronchial closure of central APF using ASD occluder is a minimally invasive but effective modality of treatment with satisfactory long-term outcome.